The Consulting Room and Beyond: Psychoanalytic Work and its Reverberations in the Analyst's Life (Book Review)

Author:  Ragen, Therese
Publisher:  Routledge, 2009
Reviewed By:  Susan DeMattos, Vol. XXIX, No. 1, Winter 2009, pp. 31-32

One of the transformative moments in my analytic education happened in a class on analytic writing when I was exposed to the advice of Stephen Bernstein (1995). Describe what happens, Bernstein (p. 7) advised, show how you the analyst helped it happen and how you understood what occurred by selecting and integrating “verbal activities, affects, experiences, and responses by both the patient and the analyst over time.” Bernstein provided a light-bulb experience for a not-so-young new candidate: something happens in analysis for both patient and analyst; I as analyst have something to do with what happens; I as analyst can feel it and learn to see it and possibly write about it.

Therese Ragen does all this in The Consulting Room and Beyond, but she also breaks the rules. Ragen begins her book by describing a patient who wonders if he could possibly have killed his twin brother when he climbed into his crib during their naptime. Something clearly happened to Ragen as she listened to this patient and yet we do not hear about this patient again and we do not hear what happened between Ragen and the patient. Instead Ragen takes us into her psychoanalytic process and tells us the story of her soul.

Ragen titles this opening chapter “Legacy” and it is statement of her writing’s impact on me that I found myself wondering about the meaning of legacy: for Ragen, for our patients, for ourselves. The chapter is in many ways a meditation on and association to the meaning of legacy. Ragen describes how her musing on whether her patient could have murdered his brother sent her into a fragmenting, dissociative state that she could only make sense of months later when she found herself crying over pictures of a murdered man when she is called for jury duty. Ragen uses her affects, experiences, and responses in communication with her consult group and family and the psychoanalytic literature on transgenerational trauma to make sense of her reaction.

Legacy, according to my dictionary, means either property or money left by will or bequest or anything handed down from ancestor to descendent. Ragen’s patient has a legacy of trauma, not yet resolved, and Ragen describes how she discovered her own legacy of trauma:

When there is little communication about the parent’s trauma, children split off what they do not know along with the fantasies they have generated to fill the gaps into a dissociated part of themselves. Later events in their own life can break open what’s split off and throw them into bewildering and upsetting feelings and images that flood their bodies and minds.

For psychoanalysts, these later events importantly include the events that transpire in psychoanalysis with patients. What is unnamed or unresolved in patients “goes in search of an echo, in this improbable other [the analyst], of what official history has marginalized or trivialized, evoking in the analyst details and anecdotes that have been unclaimed, even in his or her own analysis” (Davoine & Gaudilliere, 2004, p. 11). A remnant of something that I hadn’t fully claimed was stirred in the consultation group. It took full form in and after my day in the courtroom.
(pp. 13-14)

If trauma echoes on in our lives, as Ragen has demonstrated, what then is our responsibility for ourselves, our children, and our patients after the trauma of September 11th? Having been traumatized ourselves, how do we work and do no harm? This is a question that runs through the remaining chapters of Ragen’s book. As she listens to her patients and herself, she is willing to ask how psychoanalysis works with this sort of trauma.

Indeed, her second chapter is titled September 11, 2001 and in it Ragen describes listening to office workers close to the World Trade Center and her patients in the days following the attack. Trauma echoes in these passages and Ragen works to help her patients connect what they are feeling with what is happening in the world. She listens to herself as well, noting when her back and legs ache at the end of a long day of listening. In her entry for September 27th at 4 am, she writes of her longing to speak from a raw core into a quiet space where it is simply received and absorbed by someone who sits with her. And it struck me that Ragen was both describing what she was doing —providing a quiet space where patients’ primitive feelings were simply received and absorbed—and identifying a need in herself that she has not yet figured out how to meet. By the end of the chapter, she has found that quiet space.

In her third chapter, “Longing,” Ragen makes clear that she longs for more than quiet space:

Love . . . souls . . . these are not words in my psychoanalytic vocabulary. These are not realities through which we work and speak and have our psychoanalytic being—not often, anyhow. I miss these words, these realities. I miss them in and with my patients, in my colleagues and myself. Rank talked about love. Freud talked about the soul. How and when did we lose these parts of ourselves? (p. 36)

Ragen tells us of her younger self, named after Thérèse of Lisieux, playing being a priest performing the Eucharist with her brothers and sister. It is not only trauma that has been split off but access to spiritual and religious experience. And once again Ragen breaks the rules. Love and souls are not in the psychoanalytic vocabulary, she writes, but then she extends the psychoanalytic vocabulary by finding analysts who will talk about them. And even in stating that love and souls are not in the psychoanalytic vocabulary she uses words that echo from the Book of Common Prayer’s collect for guidance: “O heavenly Father, in whom we live and move and have our being.”

Ragen had acknowledged Carole Maso, author of “Break every rule: Essays on language, longing and desire,” and her continuing influence on Ragen’s writing. Now as I experienced Ragen breaking rules by talking about herself rather than a patient and by using words that she was saying were not in the psychoanalytic vocabulary, I got curious about what Maso had meant by “breaking every rule.” “If language is desire,” Maso (p. 158) had written, “if syntax and rhythm and tone and color create worlds of desire, if we see, if we live out on the margin, then how come we so often write between the lines?” Maso encouraged her audience to write outside the lines, to break that language contract and to “refuse to accept our limitations” (p. 159).

Ragen (pp. 43-44) writes about her patient Ben seeking a breakdown that is also a breakthrough and it strikes me that breaking the rules also seeks this sort of breakthrough, for both writer and reader.
Thomas Ogden (2005) has written that analytic writing is

. . . equal parts meditation and the experience of wrestling a beast to the ground. As a meditation, writing constitutes a way of being with myself and of hearing myself coming into being in a way that has no equivalent in any other sector of my life. This “state of writing” is very similar to my experience of reverie in the analytic setting. (p. 117)

Ragen’s writing, like Ogden’s sends me into an experience of reverie. Perhaps breaking the rules can break open experience and allow us to discover and recover split off experiences.
In commenting on a paper by Pizer, Stern (2005) wrote:

So there are two kinds of good psychoanalytic writing, and the kinds of reading they require are, in a way, mirror images of one another. In the first kind, you have to work hard to read well, and then, later on, you finally arrive at an understanding good enough that you can go back and allow the words and meanings to wash over you. In the second kind, you have to allow your imagination free rein; you have to begin by letting the words wash over you; and if you read well and imagine deeply, you may be able to think hard about it later on and understand something different. (p. 87-88)

Ragen’s writing falls in to this second group: it is very accessible and I found that when I sat down to read, I could not stop until I had read the whole book. The words washed over me and it was only at the end that I could begin to wonder what had just happened to me. It was at this point that I went back to read again, this time as poetry or sacred text, the way teachers and colleagues and students have helped me to read Freud and Winnicott, Bromberg and Ghent and Ferro: line by line, aloud to a listening other. This sort of close reading is also a close living of the text. Ragen’s writing invites this close reading and close living.

In breaking the rules, Ragen reclaims the tradition of other psychoanalytic mystics like Jung and Milner, Ghent and Eigen and Ulanov. She is in good company and she invites her reader to join her.


Bernstein, S. B. (1995). Guidelines: Comments on treatment report writing and describing analytic process. In The American Psychoanalytic Association Committee on Certification of the Board of Professional Standards, Procedures and Guidelines. New York: American Psychoanalytic Association (internal publication), pp. 7-12.
Guilbert, C. M. (1977). The proposed book of common prayer. Kingsport, TN: Kingsport Press.
Maso, C. (2000). Break every rule: Essays on language, longing, & moments of desire. Washington, DC: Counterpoint.
Ogden, T. H. (2005). This art of psychoanalysis: Dreaming undreamt dreams and interrupted cries. London: Routledge.
Stern, D. B. (2005). Commentary on paper by Barbara Pizer. Psychoanalytic Dialogues, 15, 85-93.

Reviewer Note

Susan DeMattos
Seattle, WA


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